Torsades de pointes electrocardiogram

Torsades de pointes Microchapters
Home
Patient Information
Overview
Historical Perspective
Pathophysiology
Causes
Differentiating Torsades de pointes from other Diseases
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
EKG Examples
Echocardiography
Other Diagnostic Studies
Treatment
Medical Therapy
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Torsades de pointes electrocardiogram On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Torsades de pointes electrocardiogram All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Torsades de pointes electrocardiogram
CDC on Torsades de pointes electrocardiogram
Torsades de pointes electrocardiogram in the news
Blogs on Torsades de pointes electrocardiogram
Directions to Hospitals Treating Torsades de pointes
Risk calculators and risk factors for Torsades de pointes electrocardiogram

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The EKG is the main diagnostic tool for torsades de pointes.

Electrocardiography

EKG is the main diagnostic tool in patients with Torsade de pointes. EKG findings that can be seen are:

• Progressive change in polarity of QRS about the isoelectric line occurs
• Prolonged QT interval (QT ≥ 0.60 s or QTc ≥ 0.45 s)
• Pathological U
• Rotation of the heart's electrical axis by at least 180º
• Preceded by short long and short RR-intervals
• Triggered by an early premature ventricular contraction(R-on-T PVC)
• Paroxysms of 5-20 beats at a rate ≥ 200 bpm
• Patients may revert spontaneously to a nonpolymorphic ventricular tachycardia or ventricular fibrillation

Background

1. The peaks of the QRS complexes appear to twist around the isoelectric axis.
2. Polymorphic VT is distinguished from Torsades by the absence of QT prolongation in polymorphic VT.

EKG Findings

1. Paroxysms of VT with irregular RR intervals.
2. A ventricular rate between 200 and 250 beats per minute.
3. Two or more cycles of QRS complexes with alternating polarity.
4. Changing amplitude of the QRS complexes in each cycle in a sinusoidal fashion.
5. Prolongation of the QT interval.
6. Is often initiated by a PVC with a long coupling interval, R on T phenomenon.
7. There are usually 5 to 20 complexes in each cycle.

Examples

EKG's shown below are courtesy of C. Michael Gibson MS MD, and copylefted

• 

  12 lead EKG at admission

• File:TdP.1.2.1.jpg
• File:TdP.1.2.2.jpg
• File:TdP.1.3.1.jpg
• File:TdP.1.3.2.jpg
• File:TdP.1.4.1.jpg
• File:TdP.1.4.2.jpg
• File:TdP.1.5.1.jpg
• 
• 
• 
• 

Examples from different resources

• 

  Arrhythmias in a patient with short coupled torsade de pointes

• 

  Arrhythmias in a patient with short coupled torsades de pointes degenerating in ventricular fibrillation

• 

  Arrhythmias in a patient with short coupled torsade de pointes: frequent short coupled extrasystoles

• 

  Arrhythmias in a patient with short coupled torsade de pointes: frequent short coupled extrasystoles

• 

  A 12 lead ECG recording example of TdP

Characteristic tracing showing the "twisting" (blue line) of Torsade de pointes